Papillary carcinoma of the breast
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Papillary carcinoma is an rare ductal malignancy, accounting for 1%–2% of breast carcinomas. Papillary carcinomas may be solitary or multiple. When the epithelium of a papillary carcinoma has features diagnostic of intraductal carcinoma, the lesion is classified as papillary ductal carcinoma in situ. If a cystic component is present, the tumor is described as an intracystic papillary carcinoma. In the absence of an appreciable cyst, a diagnosis of solid papillary carcinoma is appropriate. Invasive elements arising in a papillary carcinoma are almost always detected at the periphery of the lesion. Papillary carcinomas are usually well circumscribed and often contain hemorrhagic and cystic areas. The mean patient age at diagnosis of papillary carcinoma is 63–67 years. Approximately 50% of papillary carcinomas arise in the retroareolar region of the breast. Papillary carcinoma may manifest clinically as a palpable mass or nipple discharge, with the latter present in 22%–34% of patients.
Imaging Findings for Papillary carcinoma
- The most common mammographic pattern of invasive papillary carcinoma is a round, oval, or lobulated mass.
- The mass margins are usually circumscribed but may be obscured or indistinct
- US evaluation of invasive papillary carcinomas may reveal a hypoechoic and solid mass, often with posterior acoustic enhancement; alternatively, complex cystic and solid masses may be evident.
- There is overlap in the imaging patterns of invasive papillary carcinoma and papillary ductal carcinoma in situ.
- For patients presenting with nipple discharge, galactography may be helpful.
- Like papillomas, papillary carcinomas may be evident as ductal obstruction, filling defects, or focal or diffuse ductal wall irregularity.
Intracystic papillary carcinoma
